Education is over rated regarding pharmaceuticals

Implications: If I may, Mr. Goldstein suggests that education to providers re: cost/benefit or value will drive drug selection.  I disagree in that there are may barriers to provider (most physicians) behavior and their selection of drugs.  To mention a few are as follows:  1. My anecdotal experience 2. My eductation (in past). 3. Do I believe in this? 4. Is this aligned with my best interests 5. Never the first to try something new and never the last.  And so on.  If education was the dominent driver, then propranolol and a thiazide diruretic would be the first choice of anti-hypertensives based on evidence based population studies.  Yet drugs 10-20 fold more expensive are often used as first line. Adherence would increase volume and if free market dynamics are alive would decrease costs/unit.  Total cost may rise and I agree with that. Price controls have never worked--let them die.

Analysis: Education to prescribers has never been the dominent driver of use or Pharma would not be spending twice as much for advertisizing to consumers than physicians and twice as much as research (knowing the drug).  The power of the consumer culture predominates choice of drugs particularly in the last 20 years and consumers are VERY influencial in that decision making.  Physicians have a multitude of barriers to prescribing beharioral change but are most influenced by consumer input-not education.  Tort issues (as perceived by physicians) also have a role despite its non evidence based foundations.

Our culture is Technologically driven and new drugs are technology.  That is why direct to consumer advertisizing has occured with now great limitation on education going to the prescriber.  The diffusion of technology is cultural and must be approached through a long term population education program emphasizing the harm created when technology is diffused too quickly or inappropriately to marginal cases.

The issue of adherence will be with us for ever.  We need a gene for it.  However, if a drug was taken as prescribed and a patient received maximum benefit, additional drugs would likely not be added to enhance the desireable effect.  Thus, the total cost of drugs is really unknown and pure speculation.  No doubt improved adherence would improve outcomes in a specific medical issue.

Let's inform Americans of new medical  technology dangers and benefits, use tried and true therapies where they work the best, not be influenced directly or indirectly by pharma or DTC advertising, and allow the market to set the prices.